Definition: is a condition in which patients present with neurological symptoms such as numbness, blindness, paralysis, or fits without a physiological cause. It is thought that these problems arise in response to difficulties in the patient’s life, and conversion is considered a psychiatric disorder in ICD-10 and DSM-4.
Classification / type of disease:
- Diagnosis is difficult, therefore incidence hard to assess – although it is thought to be around 10-20/100,000/yr.
- More commonly seen in women (~x6 times).
- Peak onset is thought to be mid-30s
Presenting symptoms / signs:
Conversion disorder can present with any motor or sensory symptom including any of the following:
- Weakness/paralysis of a limb or the entire body (hysterical paralysis or motor conversion disorders)
- Impaired vision (hysterical blindness) or impaired hearing
- Loss/disturbance of sensation
- Impairment or loss of speech (hysterical aphonia)
- Psychogenic non-epileptic seizures
- Fixed dystonia unlike normal dystonia
- Tremor, myoclonus or other movement disorders
- Gait problems (Astasia-abasia)
- Syncope (fainting)
In diagnosis, it is important to fully rule out neurological disease, feigning/malingering, and to establish a psychological basis. A history of sexual abuse which has been repressed and then reactivated is quite common in conversion illness.
- Occupational Therapy to maintain autonomy in activities of daily living
- Treatment of comorbid depression or anxiety if present